The latest meeting of the Welsh Assembly’s Cross Party Group on Hospice and Palliative Care was recently held at on Friday 23rd November. Royal Pharmaceutical Society in Wales asked me to attend the meeting on its behalf. With RPS having just recently launched its policy on palliative and end of life care, its engagement and membership of this group is very timely.

The purpose of cross party groups is to bring together groups and organizations with expertise in a particular policy area with Assembly members who are interested in the same area. The cross party groups don’t have power, but they are used to raise Assembly members’ awareness of issues related to the field so that they can scrutinise and challenge the government and the NHS more effectively.

Darell Baker, Chief Pharmacist and Clinical Director of Pharmacy and Medicines management for Cardiff and Vale University Health Board

by Darrell Baker FFRPS, Chief Pharmacist and Clinical Director of Pharmacy and Medicines management for Cardiff and Vale University Health Board

A good life to the very end…

“For human beings, life is meaningful because it is a story, and in stories endings matter”
(Atul Gawande)

Quality palliative and end of life care is important and medicines can have a key role to play in facilitating that quality of care for many of our patients. On behalf of the Chief Pharmacists in NHS Wales, I am pleased to have supported the development of the RPS Wales policy document and to endorse its key recommendations.

Focusing on the individual

Understanding what quality end of life care looks (and feels) like for an individual is an important starting point. Pharmacy staff need to work as integrated members of the multi-professional team around the patient, with access to clinical information about the patient. This way, we are able to respect their wishes and support effective implementation of treatment and symptom management plans, regardless of location.

Getting it right – first time.

In every day working life we strive to get things right so we achieve the results that people need. It saves time, avoids duplication of effort and you get the result you want. Yet, as a community pharmacist, I see palliative care as an area where we sometimes don’t get things right first time due to the complexity of the systems and processes involved.

What happens when we get it wrong

In a real life scenario I was presented with a prescription by a patient’s relative for end of life medication on a Saturday morning. The medication prescribed was not on the Health Board Palliative Care Formulary and the family had spent most of the previous day travelling to various community pharmacies to get the prescription dispensed. I contacted the out-of-hours GP explaining the situation and the relative was asked to attend the out-of-hours service for a new prescription. They returned after lunch with a new prescription, however, the hand written prescription did not meet the controlled drugs regulations. I contacted the out-of-hours service again and the family member was asked to pick up a new prescription and return to the pharmacy. The controlled drug was supplied in part due to limited stock held but was enough to last until Monday evening. I explained we could order the remaining stock and deliver it when it arrived. After work on Monday evening I visited the patient’s address with the remaining medication only to discover the patient had sadly, already passed away on Saturday evening.

When a patient is at end of life members of the family and friends need to be with their loved ones, not chasing supplies of medication.

There’s lots to consider within this one real life scenario.

Why was a non-formulary palliative care medication prescribed?

Why was the alternative controlled drug prescription not written correctly?

Where were the communication channels to let the community pharmacy know the patient had passed away?

This single case is typical and highlights multiple opportunities to improve care at the end of life.

Getting it right in future

I welcome the upcoming policy on palliative and end of life care by the Royal Pharmaceutical Society in Wales. This leading policy will address the issues we healthcare professionals face and importantly, allows patients high quality coordinated care. Patients and carers have the right to be treated with dignity and respect. The policy outlines key areas to ensure patient empowerment through timely access to medication, providing the right support through shared health care plans and offering education and training to the workforce.

If we work on an All Wales approach and implement the key recommendations of the policy, we have the opportunity to drive quality improvements as well as reduce demands on our health and social care services. I’m fully behind the policy as I hope many of you reading this blog will be. Lets get it right – first time.

What do we pharmacists have to offer?

I have just retired, having had a very rewarding career as a palliative care pharmacist. I firmly believe pharmacy has a key role to play in supporting patients and their families, as well as other professions, in the delivery of palliative care services in both community and secondary care. Currently we are an under used resource but have the potential to offer much more to existing services.

Community Pharmacists are ideally placed to advise on the safe and effective use of medicines. The local pharmacist is a readily accessible source of information and advice for both the patient and those supporting them. With improved communication with fellow professionals in both the community and secondary care services they would be better placed to ensure the supply of essential medication and support. This in turn would help community services in supporting patients who wish to die at home.

In secondary care the inclusion of an advanced specialist pharmacist in the palliative care multidisciplinary team is beneficial in providing advice on all aspects of medicines management from the suitability and availability of drugs and the prescribing options to the use of drugs in renal and hepatic failure. Non specialist pharmacists also have a role in ensuring symptom control is optimised, appropriate and effective.

For pharmacists to reach their full potential in the field of palliative care they need access to education and, where appropriate, the opportunity to gain experience in working with palliative care patients.

The scope of palliative care includes many non-cancer diagnoses and, with an ageing population, there are more patients requiring palliative care input than ever before. Pharmacy needs to rise to the challenge. We have made a start in Wales and have formed the All Wales Palliative Care Pharmacist Group, for pharmacists with a particular interest in palliative care.

*The group undertakes projects on a national basis such as the Just in Case Box scheme and the development of the syringe driver chart and also acts as a support group for its members.

We need to build on these foundations to ensure pharmacy provides great care for palliative care patients and continues to develop expertise in palliative care medicines use across the whole range of pharmacist roles

She…

I’ve written lots of blogs on science or leadership but never about being gay, so this is my first professional outing.

I’m fortunate in that I have never experienced overt homophobia in the workplace. This is in stark contrast to my personal life, where experiences have ranged from:

– Being abandoned by groups of friends at school;
– Family members not coming to my wedding because they didn’t “agree with it”; and
– Strangers in the street shouting “You deserve to die” for simply holding hands with my girlfriend. (No, this wasn’t the 1950s, it was 2003)

Even though they haven’t been painful professional experiences, it doesn’t mean there haven’t been uncomfortable ones. Like every time someone asks “What does your husband do?”. I’ve lost count of the number of times I’ve responded “They….” or “My partner….” Because I didn’t want people to feel uncomfortable or embarrassed. But the longer you leave it, the more uncomfortable the discussion gets.

When is the right time?

So, when is the right time to say “She” or “My girlfriend” or “My wife”? Over the last few years, I’ve made a conscious decision to get “She” in early. The birth of my daughter really helped with this. As a proud parent, I would show people photographs and they would say “You look great for having a young baby” to which I could respond “Oh my wife gave birth to her, and she looks better than I do!” (See the photo below as proof). I find that openness, humour and a baby photo go a long way to diffusing any discomfort. Of course, there have been occasions where I have just taken the compliment (please don’t tell my wife)!

Dr. Claire Thompson (right) with her family

Brave

Coming out to colleagues still doesn’t come naturally, it always takes an element of bravery and I do admit that there are some people that I still don’t tell because I know they will judge me unfairly. Ultimately, we need to be comfortable with what we share about ourselves.
But if you do want people in the workplace to know that you are gay, take a deep breath and go for it.
Be brave. Be you.

With August being the month we in Wales choose to celebrate Pride, what better time for the RPS Wales team to join the ongoing campaign for unity, equality, acceptance and embracement. To show our solidarity, some of our RPS staff members will be sharing their experiences in pharmacy as members of the LBGT community, and on the 24th of August, the eve of Pride Cymru, in the office we will be donning our brightest colours, eating rainbow cakes and flying the flag in support of Pride.

Why we still need to worry about equality

I’ve found myself thinking recently – if last year marked the 50th anniversary of the 1967 Sexual Offences Act and the “de-criminalisation of homosexuality”, why are members of the LGBT community still being tormented, isolated and discriminated against? It turns out, my ignorance was distorting my understanding. In 1967 homosexuality was in fact only partially de-criminalised; many anti-gay laws remained, and criminalisation did not in fact toally end in the United Kingdom until 2013. That’s only five years ago!

Five years ago, I was in my second year of University. Through my time at University and my career to date, I have been a proud member of the LGBT community. For the majority of the time, I have felt accepted and embraced, but I can’t say I have always felt that I am, or would always be, treated the same. My sexuality is something I am conscious of in interviews, when starting new jobs or working in new teams. I am still, in 2018, worried how people will react when, for example, I correct he to she when talking about my personal life. And I am sad to hear from colleagues and friends that they have had much worse experiences, including homophobic slurs and discrimination.

Join us and show your Pride in Practice

What stands out to me clearly is that LGBT rights and support is not a moot point, and there’s still a long way to go. The celebration of the campaign and the achievements so far is as important as ever, and we hope that through our blogs and photos, we can be a part of the campaign for unity, equality, acceptance and embracement for all of our members. We’d love it for members to join us by sharing photos of your involvement this weekend, either at home or in the work place. Be sure to tag your social posts with #RPSPrideInPractice so we can share!

by Ross Gregory, Head of External Relations, Royal Pharmaceutical Society in Wales

Ross Gregory, Head of External Relations, RPS Wales

If you haven’t already heard of the Parliamentary Review of Health and Social Care in Wales, there is little doubt you soon will. Published early in the New Year and anticipated as one of the most important independent advisory reports for the NHS Wales in nearly two decades, the report makes a case for change for radically transforming the Welsh model of health and social care to make it fit and sustainable for the future.

I would recommend you take a look at the report. At less than 40 pages long, it’s far from an onerous or difficult read and you may find it provides a certain ‘feel good factor’. You may even find it provides a ray of hope that the challenges facing us in the delivery of health and social care services are being thoroughly addressed. Beyond the glow of enthusiasm and optimism however, a number of critical questions remain; Will the report have the potential to drive a revolution from within our system and significantly transform services? What will a new system look and feel like? What will this mean for pharmacy services and the future of pharmacy profession in Wales?

by Jodie Williamson MRPharmS, Pharmacist at the Royal Pharmaceutical Society

In June 2017 Public Health Wales announced that there were four confirmed cases of Measles in Newport. By July 24 the number of cases confirmed had increased to 10. This outbreak triggered a rolling vaccination programme in the area, with over 1,000 children receiving the measles-mumps-rubella (MMR) vaccine. This outbreak was caused by the same strain of measles that has affected more than 14,000 people across Europe this year, and has sadly killed 35 people to date.

So what do you need to know about measles to keep you and your family safe?

Measles is a highly infectious viral illness which is passed from person to person via droplets which are released into the air when an infected person coughs or sneezes. The virus can live on surfaces for several hours and you can catch measles just by touching that surface and then placing your hands near your nose and mouth.

The symptoms of measles are:

Cold-like symptoms such as sneezing and a high temperature

A Cough

Sore, red eyes which are sensitive to light

Small greyish-white spots on the inside of the cheeks

Reddish-brown blotchy rash which usually appears a couple of days after the other symptoms.

If you think that you or your child may have measles you should contact your GP. It is important to call the surgery before you attend so that they can take steps to reduce the risk of other patients becoming infected whilst you’re there. If you or your child has received two doses of the MMR vaccine or previously had measles then it is unlikely to be measles – there are a number of other conditions with similar symptoms.

Treating a measles infection

There is no specific treatment for measles, but there are a number of things you can do to ease the symptoms in ordinary cases.

Paracetamol can be used to reduce a high temperature and relieve pain.

Closing blinds/curtains or dimming lights can help with sensitivity to light.

A sore throat or a cough can be soothed with hot drinks, particularly those containing honey and lemon. It is important to note that honey should not be given to babies under 12 months old.

Drink plenty of fluids to avoid dehydration.

Wash away crustiness around the eyes with damp cotton wool.

Your local pharmacist will be able to advise you on the best treatment for your symptoms. They will also make sure that any medicines you buy over the counter are safe to take with your regular medication if you take any.

More serious cases of measles

Measles usually lasts for 7-10 days and although it is often unpleasant, most cases pass without any additional complications. However, some people can develop serious, and even life-threatening illnesses such as pneumonia and meningitis. Other life-changing complications can include blindness and deafness. Serious complications are more likely to develop in children under 5, children with a poor diet and people with a weakened immune system.

Warning signs of serious complications from measles to look out for include:

Shortness of breath

Sharp chest pain that is worse when breathing in

Coughing up blood

Drowsiness

Confusion

Convulsions (fits)

If you or your child develops any of these symptoms you should go to your nearest accident and emergency (A&E) department or dial 999 for an ambulance.

Stop your family from being affected in the first place

The best thing you can do to protect you and your family from measles if make sure that you have all had two doses of the MMR vaccine. The first dose is usually given to babies when they are between 12 and 13 months old, and the second dose is given at 3 years and 4 months, but it is never too late to get vaccinated. If you’re not sure if you have received the vaccine, contact your GP surgery who will be able to check your records.

Have you completed a yellow card? Are you encouraging your patients to report any adverse side effects to any medicines they are taking? All of us can do our part to help ensure healthcare products are acceptably safe for patients. Read more Yellow is the new black ›

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About the RPS blog

The Royal Pharmaceutical Society is the dedicated professional body for pharmacists and pharmacy in England, Scotland and Wales.

Our blogs are written by experts and provide thought provoking information and commentary on health, health policy issues and lifestyle choices. Here you will find opinions and comments on topics related to public health and medicine safety.

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